Intervertebral Implant

ABSTRACT

An intervertebral implant includes a three-dimensional body and a securing plate. The three-dimensional body includes a front surface and a rear surface. The three-dimensional body further includes a plurality of boreholes for accommodating fixation elements. The intervertebral implant also includes a front plate disposed at the front surface of the three-dimensional body and having a plurality of boreholes. A securing plate can be fastened to the front plate.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No. 12/969,330, filed Dec. 15, 2010, which is a continuation of U.S. patent application Ser. No. 12/432,088, filed Apr. 29, 2009, now U.S. Patent No. 7,862,616, which is a continuation of International Patent Application No. PCT/CH2003/000089, filed Feb. 6, 2003. The disclosure of each of the above-identified patent applications is incorporated by reference as if set forth in its entirety herein.

TECHNICAL FIELD

The present invention relates generally to intervertebral implants.

BACKGROUND

GB-A-2 207 607 discloses an intervertebral implant, which has a horseshoe shaped configuration with a plurality of cylindrical holes. The holes are smooth on the inside and only have a stop for the heads of the bone screws, which are to be introduced therein. A disadvantage of this arrangement is that the fastening screws, introduced therein, can be anchored only with their shaft in the bone. This does not result in a rigid connection with the horseshoe-shaped intervertebral implant. When the anchoring of the screw shaft in the bone is weakened, the intervertebral implant becomes movable with respect to the screw and the bone screws tend to migrate, endangering the blood vessels. Moreover, the loosening of the intervertebral implant can lead to a pseudoarthrosis.

U.S. Patent Publication US-A 2000/0010511 (Michelson) discloses an intervertebral implant, which, at its front surface, has two boreholes with an internal thread, into which bone screws with a threaded head can be introduced. A disadvantage of this implant is that the bone screws can become loose and are not secured against being screwed out or falling out. A further disadvantage is that the bone screws are fastened completely to the implant body itself and that therefore the latter experiences a relatively large stress.

Screws which emerge at the anterior or anterolateral edge of the vertebral body because of loosening run the risk of injuring main vessels such as the aorta and Vena calva, as well as supply vessels such as lumbar arteries and veins. Injury to these main vessels may result in internal bleeding possibly causing death within a very short time. Loosening of screws is more likely when they are not mounted angularly firmly.

SUMMARY

The present invention is to provide a remedy for the above-discussed disadvantages. The present invention is directed to an intervertebral implant which can enter into a permanent, rigid connection with bone fixation means, so that, even if the bone structure is weakened, there is no loosening between the intervertebral implant and the bone fixation means. Moreover, over a separately constructed front plate, there is tension chording for the bone fixation elements, so that the implant body experiences less stress, that is, superimposed tensions. Moreover, a securing plate enables all bone fixation elements to be secured simultaneously.

The present invention accomplishes the objective set out above with an intervertebral implant, comprising a three-dimensional body having an upper side and an under side which are suitable for abutting the end plates of two adjacent vertebral bodies. The three-dimensional body further includes a left side surface and a right side surface, a front surface and a rear surface, a horizontal middle plane between the upper side and the under side, and a vertical middle plane extending from the front surface to the tear surface. The three-dimensional body further comprising a plurality of boreholes, having openings at least at or near the front surface, passing there through and being suitable for accommodating longitudinal fixation elements. The intervertebral implant further including a front plate displaceably disposed as an insert with the front side of the three-dimensional body, where the front plate includes a plurality of boreholes having openings and in which the longitudinal fixation elements can be anchored, and whose openings overlap with the openings of the boreholes of the three-dimensional body. The intervertebral implant has a securing plate fastened substantially parallel to the front plate in such a manner that the boreholes of the front plate are covered at least partly by the securing plate. An advantage achieved by the present invention, arises essentially from the solid connection between the intervertebral implant and the longitudinal fixation elements, used to fasten it.

Compared to the two-part implants of the state of the art, for which a front plate is implanted in a separate step, the present invention has the advantage that the implantation of the intervertebral implant may be carried out in one step and, with that, can be carried out more easily and more quickly. A further advantage is that the intervertebral implant is fixed as frontally as possible at the body of the vertebra. That is, at a place where good bone material usually is present. The result is an anterior movement limitation without a greater risk to the surrounding structures. The load is still absorbed under compression by the intervertebral implant and not by the front plate or the fixation screws (longitudinal fixation elements).

A method for implanting an intervertebral implant of the present invention between two adjacent vertebral bodies includes introducing the intervertebral implant, having a three-dimensional body, a front plate, and one or more boreholes, between two adjacent vertebral bodies, attaching longitudinal fixation elements with heads through the boreholes into the vertebral bodies, and attaching a securing plate by means of a fastening agent over the heads of the longitudinal fixation elements to the front plate, such that the heads of the longitudinal fixation elements are captured between the front plate and the securing plate wherein the longitudinal fixation elements are secured against being shifted relative to the intervertebral implant.

Other objectives and advantages in addition to those discussed above will become apparent to those skilled in the art during the course of the description of a preferred embodiment of the invention which follows. In the description, reference is made to accompanying drawings, which form a part thereof, and which illustrate an example of the invention. Such example, however, is not exhaustive of the various embodiments of the invention, and therefore, reference is made to the claims that follow the description for determining the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows an exploded drawing of the intervertebral implant,

FIG. 2 shows a longitudinal fixation element in the form of a screw,

FIG. 3 shows an elevation of the intervertebral implant of FIG. 1,

FIG. 4 shows a side view of the intervertebral implant of FIG. 1,

FIG. 5 shows a three-dimensional detailed representation of the body of the intervertebral implant, which shows the connecting elements to the front plate of FIG. 6,

FIG. 6 shows a three-dimensional detailed representation of the front plate of the intervertebral implant and the connecting elements to the body of FIG. 5 and

FIG. 7 shows a completely installed intervertebral implant with front plate and securing plate.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

The intervertebral implant, shown in FIGS. 1-7, includes a three-dimensional body 10 in the form of a cage with an upper side 1 and an underside 2, which are suitable for abutting the end plates of two adjacent vertebral bodies, a left side surface 3 and a right side surface 4, a front surface 5 and a back surface 6, a horizontal middle plane 7 located between the upper side 1 and the underside 2, a vertical middle plane 12 extending from the front surface 5 to the rear surface 6 and four boreholes 9 a, which pass through the body 10 and are suitable for accommodating longitudinal fixation elements 20. The body 10 may be constructed as a hollow body, the mantle surfaces of which are provided with perforations 19. The upper side 1 and/or under side 2 of the intervertebral implant may preferably be convex in shape, not planar. A convex shape to the upper side 1 and the underside 2 allows for an improved fit with the end plates of the adjacent vertebral bodies by the intervertebral implant. Further, the side surfaces 1-6 of the intervertebral implant may be essentially convex, as well.

As shown in FIG. 7, the upper side 1 and the underside 2 of the three dimensional body 10 are provided with structuring in the form of teeth 30.

At the front surface of the three-dimensional body 10, a front plate 8 may be mounted, which is disposed perpendicular to the horizontal central plane of the intervertebral implant and through which four boreholes 9 pass and in which the longitudinal fixation elements 20 can be anchored. The front plate 8, as shown in FIGS. 5 and 6, is constructed as an insert for the three-dimensional body 10. The three-dimensional body 10 has a semicircular groove 27 extending parallel to the vertical middle plane 12 at the transitions of the left side surface 3 and the right side surface 4 (FIG. 5) to the front surface 5. Correspondingly, the front plate 8 has right and left (FIG. 6) similarly extending and similarly dimensioned, semicircular rail 28. As a result, the front plate can be pushed and positioned easily with its two lateral rails 28 into the corresponding grooves 27 of the body 10 during the production of the intervertebral implant.

In one embodiment, at least one of the boreholes 9 in the front plate is constructed so that a longitudinal fixation element 20, accommodated therein, can be connected rigidly with the front plate. A rigid connection may be accomplished, for example, owing to the fact that at least one of the boreholes 9 of the front plate 8 has an internal thread. A corresponding longitudinal fixation element 20, bone screw, with a threaded end can then be screwed together rigidly with the implant. In an alternative embodiment, the four boreholes 9 in the front plate may have an internal thread 11, so that longitudinal fixation elements 20 can be connected rigidly with the front plate 8.

As discussed, the front plate 8 may be disposed, preferably vertically to the horizontal central plane, so that it can be displaced vertically with respect to the three-dimensional body 10. By these means, “stress shielding” (protection and neutralization of mechanical stresses) is attained, which permits the end plates to be adapted to the intervertebral implant during the healing process.

The intervertebral implant may have a securing plate 18, which can be fastened by means of a screw connection parallel to the front plate 8 at the front plate 8 in such a mariner that the boreholes 9 of the front plate 8 are partly covered by the securing plate 18. The securing plate 18 may have a central borehole 17 provided, preferably, with an internal thread. Corresponding thereto, the front plate 8 has a central borehole 15 for accommodating fastening means 16. Preferably, the central borehole 15 has an internal thread 14 for accommodating a fastening means 16 in the form of a screw. The securing plate 18 may also be fastened by a bayonet catch or a click catch. By fastening the securing plate 18 to the front plate 8, the heads 21 of the longitudinal fixation elements 20 (discussed later) are contacted by the securing plate 18, so that they are secured against being ejected or screwed out.

Preferably, the boreholes 9 a of the three-dimensional body 10 do not pass either through the left side surface 3 or the right side surface 4 or completely through the front surface 5. The front surface 5, preferably, is also not crossed by the boreholes 9 a. Further, the horizontal middle plane 7 is not pierced by the boreholes 9 a. Only the axes 24 of the longitudinal fixation elements 20, introduced therein, intersect the horizontal middle plane 7 of the body 10. As seen from the front surface 5, the boreholes of the three-dimensional body 10 and the front plate diverge. The axes 24 of the boreholes of the three-dimensional plate 10 and the front plate 8 enclose an angle ranging from 20° to 60°, specifically from 36° to 48°, and more preferably an angle 13 of 42° with the horizontal middle plane 7 (FIG. 4) and an angle a ranging from 100 to 45°, specifically from 27° to 33°, and more preferably an angle a of 30° with the vertical middle plane 12 (FIG. 3). Thus, better access for introducing the screws is achieved.

In one embodiment, at least one of the boreholes 9 of the front plate 8 may taper conically towards the underside 2, so that a bone screw, with a corresponding conical head, can be anchored rigidly therein. The conical borehole preferably has a conical angle, which is smaller than the resulting frictional angle. Advisably, the conicity of the conical borehole is 1:3.75 to 1:20.00 and preferably 1:5 to 1:15.

To improve the anchoring of the bone screw in a plastic body of the intervertebral implant (discussed later), a metal sleeve with an internal thread (not shown) may be inserted in the boreholes of the front plate and three-dimensional body. The intervertebral implant may also consist only partially of an x-ray transparent plastic and, in the region of the boreholes consist of a metal, such as titanium or a titanium alloy. Improved guidance and anchoring of the bone screws in the intervertebral implant may be achieved. Further, the boreholes 9 may have a smooth internal wall, into which the threaded head of a metallic, longitudinal fixation element may cut or be molded.

Depending on circumstances, two, three, four or more longitudinal fixation elements may be connected rigidly with the intervertebral implant. Preferably, at least one fixation element should pierce the upper side and at least one fixation element the underside of the intervertebral implant. The longitudinal fixation elements 20 may have either a smooth head, so that there will not be a rigid connection with the implant or a threaded, conical or expendable end, so that there will be a rigid connection with the implant. In both cases, however, the longitudinal fixation elements 20 are secured by the securing plate against rotating out, being ejected out or falling out at a later time.

The longitudinal fixation elements 20 are preferably constructed as bone screws. As shown in FIG. 2, the longitudinal fixation elements 20, introduced into the boreholes 9, have a head 21, a tip 22, a shaft 23 and an axis 24. The head 21 may preferably be provided with an external thread 25, which corresponds to the internal thread 11 of the borehole 9, so that the heads 21 can be anchored in the boreholes 9 in a rigid manner. The shaft 23 may be provided with a thread 26, which is self-drilling and self-cutting. The load thread angle of the thread 26 has a range of between 11° to 14°, preferably between 12° and 13°, and more preferably a load thread angle of 115°. The pitch angle of the thread may have a range of between 6° and 10°, preferably between 7° and 9°, and more preferably have a pitch angle of 8°. The special pitch angle produces a self-retardation in the thread, thus ensuring that the bone screw will not automatically become loose.

In the case of a second, possibly rigid type of connection, a longitudinal fixation element 20, bone screw, may preferably be used, the head of which tapers conically towards the shaft, the conicity of the head corresponding to the conicity of the borehole of the intervertebral implant. The longitudinal fixation elements may also be constructed as threadless cylindrical pins, which are provided with a drilling tip, preferably in the form of a trocar. A further variation consist therein that the longitudinal fixation elements are constructed as spiral springs. Finally, the longitudinal fixation elements may also be constructed as single-vaned or multi-vaned spiral blades.

As shown in FIG. 7, two longitudinal fixation elements 20 pierce the upper side 1 and two longitudinal fixation elements 20 pierce the underside 2 of the body 10, thereby anchoring the intervertebral implant to the adjacent vertebral bodies.

The intervertebral implant may be produced from any material which is compatible with the body. Preferably, the three-dimensional body 10 may consist of a body-compatible plastic which has not been reinforced and which may be transparent to x-rays. The advantage over fiber-reinforced plastics, which are already known in implant technology, is that no reinforcing fibers are exposed. Such exposure may be disadvantageous clinically. In such a three-dimensional body 10 constructed of a plastic that has not been reinforced, the use bone screws may be preferable. As discussed previously, the external thread of the bone screw(s) may have a load thread angle range of 110 to 14°, and preferably between 12° to 130. A comparatively slight inclination of the load flank brings about a high clamping force. As a result, radial expansion and the danger of forming cracks in the plastic are reduced. Furthermore, the external thread of the bone screw(s) may preferably have a pitch angle between 6° and 10° and preferably between 7° and 9°.

The front plate 8 may be made from materials different than the three dimensional body 10. The front plate 8 is preferably made from a metallic material. Titanium or titanium alloys are particularly suitable as metallic materials. The complete tension chord arrangement (front plate and screws) may also be made from implant steel or highly alloyed metallic materials, such as CoCrMo or CoCrMoC. The advantage of titanium lies in that there is good tissue compatibility and the good ingrowing behavior of bones. The advantage of highly alloyed metallic materials lies in their high-strength values, which permit filigree constructions.

A brief description of a surgical procedure follows in order to explain the invention further.

The intervertebral implant, in the form of a three-dimensional body 10, is introduced between two adjacent vertebral bodies by means of a suitable instrument. Longitudinal fixation elements 20, in the form of bone screws, securing the three-dimensional body 10 are screwed/inserted by means of a suitable aiming device through the boreholes 9 of the front plate 8 into the vertebral bodies. The front plate 8 may be displaced vertically with respect to the three-dimensional body 10, such that the openings of the boreholes 9 a of the three-dimensional plate 10 and the boreholes 9 of the front plate 8 overlap, to obtain stress shielding. The securing plate 18 is fastened by means of the fastening agent 16 in the form of a screw over the heads 21 of the longitudinal fixation elements 20 at the front plate 8, so that the heads 21 of the longitudinal fixation elements 20 and, with that, the screws themselves, are captured between the front plate 8 and the securing plate 18 and secured against being shifted relative to the three-dimensional body 10 (for example, by falling out or by turning out). The fastening agent 16, in the form of a screw, preferably is provided with a thread, which is distinguished by a large self-retardation. 

1. A bone stabilizing system for stabilizing first and second vertebrae in a spinal column comprising: a plurality of bone screws having a threaded shaft and a head, the shaft having a longitudinal central axis; a three dimensional body configured for insertion between the endplates of vertebrae, the three dimensional body having an upper surface for abutting the endplate of the first vertebrae, a lower surface for abutting the endplate of the second vertebrae, and a front surface; and a front plate having a top surface and a bottom surface, the plate coupleable to the body such that the bottom surface is adjacent to and at least partially overlies the front surface, the plate having a plurality of screw holes for receiving the shafts of the screws, the screw holes extending through the plate and having an axis, at least two screw holes extending through the plate at an angle relative to the bottom surface of the plate so that the axis of the respective screw hole ranges from about 30° to about 70°.
 2. The system of claim 1 further comprising a securing plate operatively connectable to the front plate in a manner to at least partially contain at least one of the heads of the screws receivable in one of the angled screw holes between the front plate and the securing plate.
 3. The system of claim 1 further comprising a securing plate operatively connectable to the front plate in a manner to at least partially cover at least two of the angled screw holes in the front plate.
 4. The system of claim 1 wherein the front plate and at least one of the screw holes in the front plate are designed and configured such that one of the screws inserted into the angled screw hole pierces one of the upper or lower surfaces of the three-dimensional body when the plate is coupled to the three-dimensional body.
 5. The system of claim 4, wherein a plurality of the angled screw holes in the front plate and the front plate are designed and configured such that one of the screws inserted into a first angled screw hole pierces the upper surface of the three-dimensional body and another screw inserted into a second angled screw hole pierces the lower surface of the body when the plate is coupled to the three-dimensional body.
 6. The system of claim 1 wherein the axis of at least one of the angled screw holes extends toward the upper surface of the three-dimensional body when the front plate is secured to the three-dimensional body and the axis of at least one of the angled screw holes extends toward the lower surface of the three-dimensional body when the front plate is secured to the three-dimensional body.
 7. The system of claim 1 wherein the front plate is formed of a metallic material and the three dimensional body is formed from a non-metallic material.
 8. The system of claim 7 wherein the three-dimensional body is made from a plastic material.
 9. The system of claim 1 wherein the front plate has a superior surface and an inferior surface and a height between the superior surface and the inferior surface and wherein the front surface of the three-dimensional body has a height between the upper surface and lower surface that is substantially equal to the height of the front plate.
 10. The system of claim 10 wherein the front surface of the three-dimensional body has a height between the upper surface and the lower surface and the front plate has a superior surface and an inferior surface and a height between the superior surface and the inferior surface of the front plate is less than the height of the front surface of the three-dimensional body.
 11. The system of claim 1 wherein the first plate has a superior surface and an inferior surface and a height between the superior surface and the inferior surface and the three-dimensional body has a height between the upper surface and lower surface, wherein the maximum height of the three-dimensional body is substantially equal to or greater than the height of the front plate.
 12. The system of claim 1 wherein the three-dimensional body further includes at least one recess in communication with the front surface and the upper surface and at least one recess in communication with the front surface and the lower surface and the front plate is couplable with the three dimensional body so that at least one of the angled screw holes formed in the front plate aligns with the at least one recess in communication with the upper surface of the body and at least one of the angled screw holes formed in the front plate aligns with the at least one recess in communication with the under surface of the body so that one of the bone screws is insertable through one of the angled screw holes formed in the plate, through one of the plurality of recesses formed in the three dimensional bodies and into one of the vertebrae.
 13. The system of claim 1 wherein the three dimensional body includes at least one throughhole extending from the upper surface to the lower surface.
 14. The system of claim 1 wherein at least one of the angled screw holes formed in the plate includes internal threads, and at least a portion of the head of one of the screws has external threads for engaging the internal thread of the angled screw hole.
 15. The system of claim 14 wherein the front plate includes a plurality of angled screw holes having internal threads, and a plurality of screws having at least a portion of their heads externally threaded and wherein the threaded portion of the angled screw holes are conically tapered.
 16. The system of claim 2 wherein the securing plate is fastenable parallel to the front plate by at least one of a screw connection, a bayonet catch or a click catch.
 17. A spine stabilizing system for stabilizing first and second vertebrae in a spinal column comprising: a plurality of bone screws having a threaded shaft and a head, the shaft having a longitudinal central axis; a three dimensional body folined of plastic configured for insertion between endplates of the first and second vertebrae, the three dimensional body having an upper surface for abutting the endplate of a first vertebrae, a lower surface for abutting the endplate of a second vertebrae, and a front surface; and a front plate formed of a metallic material having a top surface, a bottom surface, a superior surface and an inferior surface, the plate couplable to the three dimensional body such that the bottom surface overlies the front surface, the plate having a plurality of screw holes for receiving therethrough the shaft of the screws, the screw holes having a central axis, at least two of the plurality of screw holes extending through the front plate so that the axis of the screw hole is at an angle in the range of about 30° to about 70° relative to the bottom surface of the plate, wherein a first angled screw hole is angled in the front plate toward the superior surface of the front plate and the second angled screw hole is angled in the front plate toward the inferior surface of the front plate.
 18. The system of claim 17 further comprising a securing plate operatively connectable to the front plate in such a manner to at least partially cover at least one of the angled screw holes.
 19. The system of claim 17 wherein at least one of the angled screw holes includes internal threads.
 20. The system of claim 17 wherein at least one of the screws includes external threading at least partially on its head.
 21. The system of claim 17 wherein the height of the front plate is substantially equal to the height of the front surface of the three-dimensional body.
 22. The system of claim 17 wherein the three dimensional body has a horizontal middle plane between the upper surface and the lower surface, and the front plate is coupleable to the three dimensional body such that the axis of at least two angled screw holes define an angle β ranging from about 20° to about 60° with the horizontal middle plane.
 23. The system of claim 17 wherein the three dimensional body has a vertical middle plane extending from the front surface to a back surface and the front plate is coupleable to the three dimensional body such that the axis of the at least two angled screws define an angle a ranging from about 10° to about 45° with the horizontal middle plane.
 24. The system of claim 22 wherein the three-dimensional body has a vertical middle plane extending from the front surface to a back surface and the front plate is coupleable to the three-dimensional body such that the axis of the at least two angled screws define an angle a ranging from about 10° to about 45° with the horizontal middle plane.
 25. A spine stabilizing system for stabilizing first and second vertebrae in a spinal column comprising: a plurality of bone screws having a threaded shaft and a head, the shaft having a longitudinal central axis; a three dimensional body formed of plastic configured for insertion between endplates of the first and second vertebrae, the three dimensional body having a convex upper surface for abutting the endplate of a first vertebrae, a convex lower surface for abutting the endplate of a second vertebrae, a front surface, a back surface, a right side surface and a left side surface, the three dimensional body having a horizontal middle plane between the upper and lower surface and a vertical middle plane extending from the front surface to the back surface; and a front plate formed of a metallic material having a top surface, a bottom surface, a superior surface and an inferior surface, the plate couplable to the three dimensional body such that the bottom surface overlies the front surface, the plate having a plurality of screw holes for receiving therethrough the shaft of the screws, the screw holes having a central axis, at least two of the plurality of screw holes extending through the front plate so that the axis of the screw hole is at an angle in the range of about 20° to about 60° relative to the horizontal middle plane of the body, wherein a first angled screw hole is angled in the front plate toward the superior surface of the front plate and the second angled screw hole is angled in the front plate toward the inferior surface of the front plate and wherein the height of the front plate between the superior and inferior surfaces is substantially equal to or less than the maximum height between the upper and lower surfaces of the three-dimensional body. 